Ken PerezIn the 1989 movie Field of Dreams, novice farmer Ray Kinsella walks in his cornfield and hears a voice that whispers, "If you build it, he will come." He is treated to a vision of a baseball diamond. Not surprisingly, his wife, Annie, is skeptical, but she allows him to plow under his corn to build the field.

Nothing happens at first, but eventually, a man who turns out to be Shoeless Joe Jackson, a deceased major league player, appears on the field, and in time, he brings with him seven other players who were banned in the 1919 Black Sox scandal.

In like manner, the Affordable Care Act (ACA) is an ambitious undertaking, aiming to increase coverage, improve the quality of care, and slow the growth of healthcare costs. The expansion of Medicaid and the establishment of health insurance exchanges are two of the law’s means of increasing coverage, but they are both areas where many states are not going along with the ACA, which has led to some confusion by the public. 

Ultimately, actual implementation of much of the ACA will depend on the public’s compliance with the law, especially with regard to enrollment in healthcare coverage programs among uninsured and low-income households. 

According to the April 2013 Kaiser Health Tracking Poll, an astounding 42 percent of Americans are unaware that the ACA is still the law of the land, 12 percent think that the law has been repealed by Congress, and 7 percent believe it has been overturned by the Supreme Court. Also, about half of Americans say they do not have sufficient information about the healthcare reform law to understand how it will impact their own family. Most distressingly, this share rises among the uninsured and low-income households, the primary intended beneficiaries of the ACA. 

In April, much of the media reported that Sen. Max Baucus (D-Mont.), in an exchange with HHS Secretary Kathleen Sebelius, had called the federal government’s implementation of the ACA “a huge train wreck.” However, the context of Baucus’s statement was his sympathizing with small business people struggling with the complexity of the healthcare reform law. As Ezra Klein reported on April 19 in the Washington Post, Baucus stated, “I just tell you, I see a huge train wreck coming down. You and I have discussed this many times and I don’t see any results yet. What can you do to help all these people around the country going, ‘What in the world do I do and what—how do I know what to do?’”

Given the continued lack of understanding by a large proportion of the populace—especially the very demographic groups that stand to benefit the most from the ACA—the promise of “If you build it, he will come” more appropriately takes the form of a couple of questions: “If you implement the ACA, will citizens participate?” and “If you build health insurance exchanges, will they enroll?”  


Ken Perez is senior vice president and director of Healthcare Policy, MedeAnalytics, Inc., Emeryville, Calif.

Publication Date: Thursday, May 30, 2013